I’m lactose-intolerant. Can I eat dairy anyway?

I recently learnt that I am lactose-intolerant. Do I need to avoid all dairy or are some products safe to eat?

Some 30 million to 50 million people in the United States have lactose intolerance. This means their bodies cannot adequately break down lactose, the sugar present in milk.

The result can be uncomfortable gas, bloating, nausea, diarrhoea and abdominal pain – symptoms that typically occur within 30 to 60 minutes of eating a lactose-rich food, said dietitian and assistant professor of nutrition Beth Ferrell Jenks at the University of North Carolina at Chapel Hill.

The good news: While individual tolerances to dairy foods can vary, certain lower-lactose dairy products, like hard cheese and yogurt, can help keep lactose intolerance symptoms at bay.

How to eat with lactose intolerance

Trouble with lactose intolerance tends to begin in adulthood, when your body gradually makes less lactase, an enzyme that breaks down lactose.

Some people might not notice this change in their digestion, said Dr Suneeta Krishnareddy, a gastroenterologist at Columbia University Irving Medical Center in New York City.

But others may have symptoms so severe that they experience nausea and vomiting after eating certain foods, said Dr Nitin K. Ahuja, a gastroenterologist at Penn Medicine in Philadelphia.

Understanding your triggers involves some trial and error. You might start by eliminating all dairy from your diet, and then gradually reintroducing small amounts of certain foods and drinks containing lactose to see how you feel afterwards.

Here are the dairy products most, and least, likely to exacerbate your symptoms.

The worst offenders

Dairy milk

Skim, 1 per cent, 2 per cent and whole milk all contain between 12 and 12.5g of lactose a cup. That is around the maximum amount of lactose people with an intolerance can consume a day without having symptoms, said Dr Ella Haddad, a dietitian and professor emeritus of nutrition at Loma Linda University in California. So, try to limit yourself to one glass of milk a day, or less if you are consuming other types of dairy.

Unaged (or fresh) cheese

Cheese generally contains less lactose than milk, but some varieties have more than others. Cheeses that have not been aged – meaning they have not been left to ripen for weeks, months or years – typically contain more lactose than aged cheeses, Prof Jenks said. This is because during the ageing process, bacteria break lactose down, converting it into lactic acid.

Unaged cheeses tend to be soft and moist and often come in a tub. A half-cup serving of cottage cheese with 2 per cent milk fat contains about 4g of lactose. Two tablespoons of fat-free cream cheese has nearly 2g. While unaged cheeses are probably more tolerable than dairy milk, Prof Jenks recommended limiting them when you have the choice. 

Ice cream

Ice cream, which is made mainly from milk and cream, is rich in lactose and therefore should be limited. But some versions contain more lactose than others. If an ice cream contains more milk than cream – you can tell by checking if milk is listed before cream on the ingredients list – it is probably rich in lactose and therefore harder to digest, Dr Haddad said. This is because milk contains more lactose than cream.

Okay in moderation

Hard cheese

Varieties such as parmesan, cheddar and Swiss have been aged and therefore contain very little lactose and are often easier to digest than softer, unaged varieties, Dr Krishnareddy said. Harder cheeses tend to taste sharper and include an outer rind. A roughly 40g serving of parmesan or cheddar, for instance, contains less than one-tenth of a gram of lactose.

Other fermented dairy products

Fermented dairy foods like yogurt, kefir and sour cream contain bacteria that help break down lactose, Dr Krishnareddy said. This lessens the load on your small intestine, making those foods easier to digest.

Butter

This kitchen staple is made from milk, cream or both by separating the fat from the rest of the liquid, leaving most of the lactose behind, Dr Haddad said. One pat of butter and one tablespoon of cream each contains about half a gram of lactose or less.

What else can help

Many supermarkets carry lactose-free dairy products such as milk, cheese, yogurt and ice cream. They are regular dairy products made from milk, but with the lactase enzyme mixed in. This makes them more tolerable if you are lactose-intolerant, Prof Jenks said.

Dairy-free products such as milk made from almonds, soya or oats; cheese made from nuts; and ice cream made from soya or coconut are also lactose-free.

Over-the-counter lactase enzyme supplements, which can be swallowed or chewed, can help reduce your indigestion symptoms when taken with a meal. They contain the lactase enzyme so your body does not have to make it itself, Dr Krishnareddy said.

While many people can tell if they are lactose-intolerant on their own, Dr Ahuja said it is usually a good idea to see a doctor for a proper diagnosis. Other conditions, such as food allergies and inflammatory bowel disease, can cause similar symptoms. NYTIMES